Annals of Occupational and Environmental Medicine

Original Article

Evaluating the efficacy of prednisolone for silicosis with progressive massive fibrosis in Australia: an observational pilot study: Hayley Barnes, David P. Nadebaum, Daniel Niewodowski, J. K. Khoo, Yuan Z. Lim, Bradley Gardiner, Tiffany Lin, Martin Cherk, Miranda Siemienowicz, Jyotika D. Prasad, Ryan Hoy; Ann Occup Environ Med 2026;e16. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e16 [Accepted]

Abstract PDF: Background
There has been a resurgence of silicosis, particularly related to artificial stone. There are currently no treatments for silicosis beyond lung transplantation for end-stage disease. To evaluate the efficacy of prednisolone in people with artificial stone-associated silicosis–progressive massive fibrosis (PMF).
Methods
This was a pilot prospective observational clinical trial, assessing 3 months of prednisolone in adults with artificial stone–associated silicosis with PMF. Outcomes were assessed at 3 and 12 months.
Results
Seven participants completed the study. Baseline positron emission tomography (PET) scans demonstrated increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in areas of PMF in all participants. All participants had a significant reduction in maximum standardized uptake value (SUVmax) following prednisolone at 3 months (pre-treatment mean SUVmax 6.7 [standard deviation (SD): 2.6], post-treatment mean SUVmax 4.2 [SD: 1.0], p = 0.01). There was also a non-significant reduction in the % of total lung parenchyma with SUV >1 (49.7% [SD: 36.4] to 45.8% [SD: 28.4], p = 0.52) and a significant reduction in SUV >2.5 (7.0% [SD: 6.3] to 2.4% [SD: 2.2], p = 0.03). There was a non-significant reduction in computed tomography ICOERD well-defined opacity profusion scores and large opacities. There was no significant difference in lung function or St. George's Respiratory Questionnaire. There were no serious adverse events.
Conclusions
There are high levels of inflammation in silicosis-PMF as evidenced by 18F-FDG PET. Short-term prednisolone reduced 18F-FDG PET activity. This suggests a possible therapeutic pathway for people with silicosis-associated PMF in a population with no current treatments. Further research is required to determine the most appropriate immunosuppressive strategy and further assess longer-term outcomes.

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Original Article

Relationship between obstructive sleep apnea risk and low back pain among shift workers in a tire manufacturing factory: Sunjin Jung, Seunghyeon Cho, Suwhan Kim, Kyung Wook Kang, JiHwan Kim, Won-Ju Park; Ann Occup Environ Med 2026;e15. Published online May 12, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e15 [Accepted]

Abstract PDF: Background
Low back pain (LBP) is highly prevalent among industrial workers, and obstructive sleep apnea (OSA) has been increasingly recognized as a factor influencing pain modulation. This study evaluated the association between OSA risk, assessed by the STOP-Bang questionnaire, and LBP among shift workers in a tire manufacturing factory.
Methods
A total of 976 male shift workers from a tire manufacturing factory were analyzed. OSA risk was assessed using the STOP-Bang questionnaire and classified as low, moderate, or high. LBP and musculoskeletal pain were defined as self-reported symptoms occurring within the preceding 6 months. Multivariable logistic regression analyses were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Compared with workers at low OSA risk, those at moderate and high risk had significantly higher odds of LBP (OR: 1.50; 95% CI: 1.02–2.20; p = 0.038; and OR: 1.75; 95% CI: 1.20–2.55; p = 0.004, respectively). Similarly, moderate and high OSA risk were independently associated with increased odds of musculoskeletal pain (OR: 1.86; 95% CI: 1.26–2.73; p = 0.002; and OR: 1.84; 95% CI: 1.26–2.68; p = 0.002, respectively).
Conclusions
Among male shift workers, elevated OSA risk is independently associated with a higher prevalence of LBP and musculoskeletal pain. Systematic workplace screening for OSA risk using the STOP-Bang questionnaire may support occupational health assessments by identifying shift workers with elevated OSA risk who are more likely to report pain-related morbidity.

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Case Report

Reactive airways dysfunction syndrome following acute lithium hydroxide dust exposure at a battery material production plant: a case series of 16 workers: Chul Gab Lee, Soo Hyeong Park, Jeong Joon Park, Han Soo Song, Hyeon Kyeong Ko, Sung Ho Yoon; Ann Occup Environ Med 2026;e17. Published online June 4, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e17 [Accepted]

Abstract PDF: Background
Reactive airways dysfunction syndrome (RADS) is an acute-onset form of irritant-induced asthma that occurs after a single high-concentration exposure to irritants. Although RADS has been documented for chlorine, ammonia, and acid fumes, no published case series has attributed RADS to lithium hydroxide (LiOH) dust inhalation. We report the clinical features, diagnostic evaluation, and longitudinal management of 16 workers with persistent respiratory symptoms following acute occupational LiOH exposure at a battery cathode material production facility.
Case Presentation
In March 2024, a silicone connector failure resulted in the leakage of approximately 50–100 kg of LiOH powder at a facility in Korea, exposing over 500 workers. Sixteen workers (15 men, 1 woman; mean age 53.4 years) with persistent respiratory symptoms were evaluated at the Department of Occupational and Environmental Medicine. Most patients presented with cough and sputum production; 56.3% (9/16) exhibited nocturnal or early-morning exacerbation. Methacholine challenge testing was performed in 10 patients, with positive results in three patients (PC20 [provocative concentration causing a 20% decline in forced expiratory volume in 1 second]: 1.36–6.74 mg/mL). By the Brooks 1985 criteria, one case was classified as definite RADS, four as probable, six as possible, and five as unlikely; American College of Chest Physicians 2008 cross-validation yielded identical classifications. Workers' compensation recipients had significantly longer follow-up (18–23 months) compared to non-recipients (1–3 months). Pharmacological management was symptom-directed, combining leukotriene receptor antagonists, mucolytics, antihistamines, and acid-suppressive therapy.
Conclusions
Acute high-concentration LiOH dust inhalation may induce RADS characterized by persistent respiratory symptoms and bronchial hyperresponsiveness. The extreme alkalinity, high water solubility, and exothermic dissolution of LiOH provide a plausible mechanistic framework for airway injury. Clinicians should consider RADS in workers presenting with persistent respiratory symptoms after alkaline dust exposure, even when routine investigations are unremarkable. Attention should also be given to the psychological burden associated with prolonged, poorly recognized symptoms.

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